2013-05-14T12:06:07-05:00 2012-06-30 621517792 PERSHING YOAKLEY & ASSOCIATES P C ONE CHEROKEE MILLS 2220 SUTHERLAND KNOXVILLE TN 379192363 990 2011-07-01 540544705 JOHNSTON MEMORIAL HOSPITAL INC JOHN 2762581000 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 JOHN JETER 2762581000 2013-05-13 1 DEBORAH O ERNSBERGER P00364912 8656730844 2011 2016-02-24 21:20:13Z JOHN L JETER 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 122110940 0 X HTTP://WWW.JMH.ORG X 1917 VA TO RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 14 9 0 249 11972 9875 18506 43128 111418571 117916395 3914394 -457034 635944 1375328 115987415 118877817 90098 63766 0 0 48436329 52153382 0 0 4706 58964455 67924644 107490882 120141792 8496533 -1263975 349751817 311573030 64585564 54093206 285166253 257479824 X JOHNSTON MEMORIAL HOSPITAL, INC. IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 0 0 84591440 63766 117916395 JOHNSTON MEMORIAL HOSPITAL ("HOSPITAL") IS A TAX-EXEMPT COMMUNITY-BASED HOSPITAL, WHICH IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. TEAM MEMBERS OF JOHNSTON MEMORIAL HOSPITAL RECOGNIZE A CORE SET OF VALUES TO HELP ASSURE OUR PATIENTS RECEIVE HIGH QUALITY AND COMPASSIONATE CARE AT A REASONABLE COST. THESE VALUES ARE:- INTEGRITY - HONESTY IN EVERYTHING WE DO- SERVICE - WITH CARING AND COMPASSION- LEADERSHIP - WITH CREATIVITY AND INNOVATION- EXCELLENCE - ALWAYS PURSUING A HIGHER STANDARDIN FISCAL YEAR 2012, JOHNSTON MEMORIAL HOSPITAL PROVIDED PATIENT CARE TO OVER 7,135 IN-PATIENTS, REPRESENTING 25,511 INPATIENT DAYS AND 1,595 NEWBORN DAYS. WE ALSO PROVIDED OUTPATIENT SERVICES TO OVER 121,711 PATIENTS. CARE GIVEN TO MEDICARE AND MEDICAID PATIENTS MAKE UP APPROXIMATELY 64% OF THE HOSPITAL'S TOTAL PATIENT REVENUE.COMMUNITY HEALTH EDUCATION AND OTHER COMMUNITY SUPPORTRECOGNIZING OUR MISSION TO THE COMMUNITY IN THE AREA OF HEALTH CARE EDUCATION, JOHNSTON MEMORIAL HOSPITAL AND ITS TEAM MEMBERS OFFER MANY FREE PROGRAMS THROUGHOUT THE YEAR AIMED AT IMPROVING COMMUNITY HEALTH. WE OFFERED THE FOLLOWING EDUCATIONAL CLASSES AND PROGRAMS:- ONGOING CANCER EDUCATION CLASSES- ONGOING DIABETES EDUCATION- ADVANCED CARDIAC LIFE SUPPORT CERTIFICATION COURSE- PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION COURSE- CARDIO PULMONARY RESUSCITATION CERTIFICATION COURSE- TOTAL JOINT CLASSES- BABY ON THE WAY, BREASTFEEDING, PARENTING COURSES- ANNUAL BABY FAIR- PROSTATE CANCER SCREENING- AED TRAINING AND EDUCATION- DIABETES EDUCATION HEALTH FAIR- HEART SAVER FIRST AID CLASSES FOR DAY CARE, SCHOOLS, CHURCHES, ETC.- MONTHLY LUNCH AND LEARN AT LOCAL RECREATION CENTER- HEALTHY COOKING DEMONSTRATION- ANNUAL SPORTS PHYSICALS FOR LOCAL HIGH SCHOOLSWE SPONSORED OR ASSISTED LOCAL SUPPORT GROUPS IN THE FOLLOWING PROGRAMS:- HEART-TO-HEART EDUCATIONAL SUPPORT GROUP- CANCER EDUCATION SUPPORT GROUP- DIABETES EDUCATION SUPPORT GROUP- RESOLVE THROUGH SHARING SUPPORT GROUP - FOR THOSE GRIEVING THE LOSS OF NEWBORNS- ANNUAL ASTHMA CAMP- LADIES NIGHT OUT (BREAST CANCER AWARENESS EVENT)JOHNSTON MEMORIAL HOSPITAL RECOGNIZES THE IMPORTANCE OF HEALTH CARE EDUCATIONAL PROGRAMS TOWARD PROVIDING QUALITY HEALTH CARE TO OUR COMMUNITIES. IN FISCAL YEAR 2012, WE SUPPORTED A NURSING INSTRUCTOR POSITION AT THE LOCAL COMMUNITY COLLEGE TO ASSIST IN MAINTAINING AND DEVELOPING THE NURSING PROGRAM. IN ADDITION, WE PROVIDED A CLINICAL SETTING FOR MANY STUDENTS TRAINING IN HEALTH RELATED PROGRAMS SUCH AS REGISTERED NURSING, LICENSED PRACTICAL NURSING, RADIOLOGY, LAB, AND RESPIRATORY. JOHNSTON MEMORIAL HOSPITAL ALSO RECOGNIZES THE IMPORTANCE OF SUPPORTING OUR NOT-FOR-PROFIT COMMUNITY BASED ORGANIZATIONS IN FUNDRAISING AND OTHER EVENTS. THE HOSPITAL AND OUR EMPLOYEES CONTRIBUTED OVER $64,000 IN CASH AND IN-KIND CONTRIBUTIONS TO OUR COMMUNITY IN FISCAL YEAR 2012 TO SUCH ORGANIZATIONS AS THE AMERICAN LUNG ASSOCIATION, MARCH OF DIMES, UNITED WAY, RELAY FOR LIFE CANCER FUNDRAISER, AND MANY OTHERS. 84591440 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 130 0 0 1 1 0 0 0 0 0 0 0 0 0 X 14 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X JOHN L JETER 2762581000 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 X KATHY MITCHELL 1.00 X 0 0 0 EMORY ROBINETTE MD 1.00 X 0 0 0 MICHAEL SPIEGLER 1.00 X 16250 0 0 CHARLES SYDNOR JR 1.00 X 0 0 0 LARAMIE TRIPLETT MD 1.00 X 68259 0 0 DENNIS VONDERFECHT 1.00 X 0 1099588 167285 PAUL ARMSTRONG MD 1.00 X 626 325458 26597 OTEY DUDLEY 1.00 X 0 0 0 HUGH FERGUSON 1.00 X 0 0 0 ANN FLEMING 1.00 X 0 501320 66728 TOM FOWLKES 1.00 X 0 0 0 JOANNE GILMER 1.00 X 0 0 0 DONALD JEANES 1.00 X 0 0 0 BRENDAN MCSHEEHY JR 1.00 X 0 0 0 SEAN MCMURRAY 55.00 X 0 337488 46968 JOHN JETER 55.00 X 0 141277 20972 TIMOTHY EVANS 55.00 X 0 121572 15299 STEPHEN GIVENS 55.00 X 0 193040 29104 DAMIAN SOOKLAL MD 55.00 X 0 341099 24078 STEVEN SIKORA MD 55.00 X 0 334496 27151 STEVEN BLANKENSHIP MD 55.00 X 0 314529 29661 DOUGLAS LAWLER MD 55.00 X 0 319066 31139 JACQUELYN EARLY MD 55.00 X 0 314729 17862 85135 4343662 502844 0 0 1 0 RJ GRIFFIN & COMPANY 800 MT VERNON HWY SUITE 200 ATLANTA GA 30328 CONSTRUCTION MANAGEMENT 17560976 VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON VA 24210 ANESTHESIA 2613092 ABINGDON PHYS AMB SURG MGMT GROUP 613 CAMPUS DRIVE STE 300 ABINGDON VA 24210 ASC MANAGEMENT 524620 MEDIAS LLC PO BOX 10452 BLACKSBURG VA 24062 SLEEP STUDY 472812 LINDE HEALTHCARE STAFFING INC PO BOX 915241 DALLAS TX 753915241 HEALTHCARE STAFFING 376302 9 22805 3347 16976 43128 NET PATIENT REVENUE 621500 117602923 117595117 7806 PARTNERSHIP INCOME 561000 313472 4166 309306 117916395 2681953 2681953 557381 0 557381 557381 557381 94136 3233123 0 -3233123 94136 -3138987 -3138987 CAFETERIA 722100 643084 643084 MANAGEMENT FEE 561000 155845 155845 MISCELLANEOUS 900099 18488 18488 530 530 817947 118877817 117595117 11972 1227600 63766 63766 960810 27500 933310 43528224 36998407 6529817 1582560 1354262 228298 3431053 3384809 46006 238 2650735 2509142 141593 41576 41576 85052 375 84677 1362 1362 218248 218248 15211736 11699621 3507597 4518 403890 323966 79924 1956905 1435421 521534 -50 726949 719382 7567 1718494 1130472 588022 259758 244182 15576 109575 67714 41861 2455844 2455844 15619712 30984 15588728 279341 15109 264232 MEDICAL SUPPLIES & DRUG 21608445 21608445 MANAGEMENT FEES 3569684 3569684 REPAIRS & MAINTENANCE 3090804 2552149 538655 TAXES -5581 -5581 572850 425734 147116 120141792 84591440 35545646 4706 2305269 9921892 16224301 19599621 984575 787969 4049872 3256748 822058 1071588 241593248 61637467 180381769 179955781 116676009 90279466 35200 35200 28272764 6664765 349751817 311573030 18255842 10337254 14115000 24870000 32214722 18885952 64585564 54093206 X 285151875 257479989 14378 -165 285166253 257479824 349751817 311573030 X -1263975 -26422454 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4896776 4896776 145199774 11878220 133321554 6087656 349660 5737996 83605341 49321544 34283797 1803701 88043 1715658 179955781 CAPITAL LEASE OBLIGATIONS 17083432 MEDICARE AND MEDICAID, NET 1225518 DUE TO AFFILIATES 577002 18885952 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL AND ABINGDON PHYSICIAN PARTNERS ("APP") ARE CLASSIFIED AS ORGANIZATIONS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AT JUNE 30, 2012, TAX RETURNS FOR FISCAL YEARS 2009 THROUGH 2011 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2012 AND 2011. AS SUCH, NO INTEREST OR PENALTIES ARE RECOGNIZED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RELATED TO UNCERTAIN TAX POSITIONS. 1 1 X 1 X 1 X 1 1 1 0 0 2175436 2175436 0.01830 13965412 9843178 4122234 0.03460 16140848 9843178 6297670 0.05290 153304 153304 0.00130 381194 381194 0.00320 27524 27524 0.00020 562022 562022 0.00470 16702870 9843178 6859692 0.05760 18500 18500 0.00020 18500 18500 0.00020 1 3639092 1819546 37843855 48010733 -10166878 X 1 1 1 1 JOHNSTON MEMORIAL HOSPITAL INC

16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211

X X X JOHNSTON MEMORIAL HOSPITAL INC 1 1 X X X X X X X X 11 1 1 1 X X X X X X X X 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X 1 0 1 X 0 0 PART I, LINE 6A: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) HAS HISTORICALLY PREPARED AND MADE PUBLIC A COMMUNITY BENEFIT REPORT TO INCLUDE INFORMATION FOR ALL OF THE HOSPITALS WITHIN THE HEALTH SYSTEM. DURING FY12, MSHA DID NOT ISSUE A COMMUNITY BENEFIT REPORT. HOWEVER, MSHA INTENDS TO PREPARE A COMMUNITY BENEFIT REPORT DURING FY13. PART I, LINE 7: A COST TO CHARGE RATIO WAS DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 965830. PART II: THE ACTIVITIES REPORTED IN PART II SEEK TO ACHIEVE SPECIFIED OBJECTIVES, INCLUDING: IMPROVING ACCESS TO HEALTH SERVICES, ENHANCING PUBLIC HEALTH, AND RELIEF OF GOVERNMENT BURDEN. THE ACTIVITIES ARE AVAILABLE TO THE GENERAL PUBLIC, FOCUSING ON LOW-INCOME CONSUMERS. PART III, LINE 4: THE CALCULATED COST TO CHARGE RATIO (WORKSHEET 2) WAS APPLIED TO BAD DEBT CONTRA REVENUE AND PROVISION FOR BAD DEBT, IN DETERMINING LINE 2.THE VICE PRESIDENT OF PATIENT FINANCIAL SERVICES AND CFO ESTIMATE THAT 50% OF TOTAL BAD DEBT EXPENSE WAS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. WE HAVE MANY INSTANCES DURING THE YEAR OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR CHARITY CARE. ALTHOUGH HOSPITAL TEAM MEMBERS ENCOURAGE THESE INDIVIDUALS TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION, MANY WILL NOT DO SO. EVEN WHEN THESE INDIVIDUALS ARE TOLD WE FEEL SURE THEY DO QUALIFY FOR FULL OR PARTIAL ASSISTANCE, THEY STILL REFUSE TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION.REGARDING LINE 3, IT IS IMPLAUSIBLE TO DETERMINE THE AMOUNT OF JMH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETE FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSESSMENT FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT MORE THAN 90% OF OUR PATIENTS WHO HAVE PROVIDED COMPLETED FINANCIAL ASSESSMENT FORMS HAVE BEEN APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE.FOOTNOTE DISCLOSURE FROM JMH'S FY12 AUDITED FINANCIAL STATEMENT READS "NEW ACCOUNTING PRONOUNCEMENTS: IN JULY 2011, THE FASB ISSUED ACCOUNTING STANDARD UPDATE (ASU) 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE ASU REQUIRES THE CHANGE OF PRESENTATION OF THE ESTIMATED PROVISION FOR BAD DEBTS IN THE CONSOLIDATED STATEMENTS OF OPERATIONS FROM AN OPERATING EXPENSE TO A DEDUCTION FROM PATIENT SERVICE REVENUE, NET OF CONTRACTUAL DEDUCTIONS AND DISCOUNTS, ALONG WITH ADDITIONAL DISCLOSURES ABOUT THE POLICIES FOR RECOGNIZING REVENUE AND ASSESSING BAD DEBTS, AND QUALITATIVE INFORMATION ABOUT CHANGES IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL RETROACTIVELY ADOPTED ASU 2011-07 IN FISCAL YEAR 2012. THE ADOPTION OF ASU 2011-07 DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS."THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENT REPORT THE AMOUNT OF ESTIMATED UNCOLLECTIBLE SELF-PAY AND EXPLAIN THAT UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE ESTIMATED RESERVES ARE BASED UPON PRIOR COLLECTION HISTORY FOR GROUPS OF RECEIVABLES, KNOWN COLLECTION RISKS AND OTHER ENVIRONMENTAL FACTORS, INCLUDING THE AGE OF THE RECEIVABLES. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING JMH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP DOWN METHOD. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION, MAGAZINES, OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT (30%) ASSOCIATED WITH THE CARE OF THE PATIENT. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. AS A NOT-FOR-PROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, JMH IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE IT IS ONLY LOGICAL TO ALLOW MSHA TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT ON THIS DOCUMENT. BY MAKING THIS CHANGE, NON-PROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS. PART III, LINE 9B: JMH PROVIDES A PATIENT FRIENDLY BILLING FLOW CHART ON ITS WEBSITE THAT GUIDES A PATIENT THROUGH THE PROCESS, BEGINNING WITH ADMISSION AND ENDING WITH THE PATIENT'S ACCOUNT BEING SUCCESSFULLY RESOLVED.JMH FOLLOWS A STRONG COLLECTION PROGRAM THAT COMMUNICATES FINANCIAL RESPONSIBILITY TO THE PATIENT. COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY AND NON-CHARITY. IN ROUTINE CIRCUMSTANCES WHEN IT IS DETERMINED THAT A PATIENT HAS NOT RESPONDED TO REQUESTS FOR PAYMENT, AN ACCOUNT CAN BE REFERRED TO AN OUTSIDE COLLECTION AGENCY FOR COLLECTION ASSISTANCE. JMH ENSURES THAT OUTSIDE COLLECTION AGENCIES FOLLOW HOSPITAL BILLING AND COLLECTION GUIDELINES. ONCE A DELINQUENT PATIENT ACCOUNT HAS BEEN SUBMITTED TO AN OUTSIDE COLLECTION AGENCY IT CAN BE RETRACTED IF IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL REQUESTS FOR FINANCIAL ASSISTANCE MUST BE ACCOMPANIED BY A COMPLETED FINANCIAL ASSESSMENT FORM AND SUPPORTING DOCUMENTATION. JOHNSTON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 3: MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES, INCLUDING JMH, LOCATED IN NINE COUNTIES WITHIN MSHA'S CORE SERVICE AREA. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY IMPLEMENTATION PLAN. JOHNSTON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 4: EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. WE SURVEYED 21 INDIVIDUALS FROM WASHINGTON COUNTY IN ORDER TO DETERMINE HEALTH PRIORITIES. DICKENSON COUNTY COMMUNITY HOSPITAL AND NORTON COMMUNITY HOSPITAL ALSO HAS ONE COMMUNITY GROUP SURVEYED. THESE TWO COUNTIES SERVE SIMILAR COMMUNITIES AND HAVE SIMILAR HEALTH RANKINGS ACCORDING TO AMERICA'S HEALTH RANKINGS. EVEN THOUGH ONLY TWO COMMUNITY GROUPS SERVED ON BEHALF OF THE FOUR HOSPITALS LISTED, STATISTICAL DATA WAS COLLECTED FOR EACH INDIVIDUALLY.JMH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER, FRANKLIN WOODS COMMUNITY HOSPITAL, WOODRIDGE PSYCHIATRIC HOSPITAL, JAMES H. & CECILE C. QUILLEN REHABILITATION HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, AND NORTON COMMUNITY HOSPITAL. JOHNSTON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 7: MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29 OF FY 12. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. NOW THAT THE IMPLEMENTATION PLANS HAVE BEEN ADOPTED, MSHA WILL BE ABLE TO BEGIN TAKING ACTION TO IMPROVE THE HEALTH PRIORITIES IN EACH COUNTY, THOUGH AT THIS POINT, NOT ALL OF THE PRIORITIES HAVE BEEN ADDRESSED. DUE TO LACK OF RESOURCES, SOME OF THE MSHA FACILITIES WERE UNABLE TO ADDRESS ISSUES THAT WERE IDENTIFIED. JOHNSTON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 13G: DURING THE ADMISSION PROCESS, PATIENTS ARE TOLD THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY AND ADMISSION PAPERS ARE GIVEN TO EACH PATIENT ADVISING THEM OF THE POLICY. BILLING CORRESPONDENCE ALSO ADVISES THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. A COMMUNITY RESOURCE GUIDE REPORTS THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY. JOHNSTON MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 19D: UNINSURED PATIENTS RECEIVE A 50% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. PART VI, LINE 2: MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. TENNESSEE RANKED 39TH AND VIRGINIA RANKED 20TH; HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE MSHA FACILITIES ARE LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 67 INDIVIDUALS REPRESENTING THE NINE COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NON-PROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE HEALTH STATUS, HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NON-PROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.24 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). ALSO, ALL 67 PARTICIPANTS AGREED THAT OBESITY, CANCER, HEART DISEASE AND DIABETES WERE THE TOP HEALTH PRIORITIES IN EACH COUNTY. AHR REPORTS THAT TENNESSEE AND VIRGINIA BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. TENNESSEE ALSO RANKED 44TH FOR CARDIOVASCULAR DISEASE AND 46TH FOR CANCER DEATHS. VIRGINIA OVERALL HAD A BETTER RANKING IN THESE TWO CATEGORIES, BUT AS STATED EARLIER, SOUTHWEST VIRGINIA CLOSELY RESEMBLES TENNESSEE. MSHA PLANS TO USE THE AVAILABLE RESOURCES TO START IMPROVING THE HEALTH STATUS OF NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. PART VI, LINE 3: JMH PROVIDES COMMUNICATION OF FINANCIAL ASSISTANCE ON ITS WEB SITE AND ON POSTERS PLACED IN PROMINENT AREAS SUCH AS ADMITTING AREAS, EMERGENCY DEPARTMENTS AND PATIENT PAYMENT (CASHIER) LOCATIONS. PRINTED EDUCATIONAL MATERIALS INCLUDING FINANCIAL ASSISTANCE CONTACT INFORMATION ARE ALSO PROVIDED IN THE PATIENT'S ADMITTING PAPERWORK. POSTERS AND REFERENCE MATERIALS ARE WRITTEN IN BOTH ENGLISH AND SPANISH. ADMITTING STAFF ARE TRAINED TO EDUCATE PATIENTS ON JMH'S FINANCIAL ASSISTANCE POLICY. JMH ALSO HAS FINANCIAL COUNSELORS WHICH COMMUNICATE THE PATIENT'S FINANCIAL RESPONSIBILITY PRIOR TO SERVICE AS WELL AS PROVIDE EDUCATION ON JMH'S FINANCIAL ASSISTANCE POLICY. THESE COUNSELORS ALSO HELP UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDICAID. IN ADDITION, JMH CONTRACTS WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. FIRSTSOURCE SOLUTIONS USA DETERMINES A PATIENT'S ELIGIBILITY IN MEDICAL COVERAGE OPTIONS AND ASSISTS WITH THEIR ENROLLMENT. JMH BEARS THE COST FOR THE FIRSTSOURCE SOLUTIONS USA PROGRAM. PART VI, LINE 4: JMH IS LOCATED IN ABINGDON, WASHINGTON COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. BOTH NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA (SWVA) ARE LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION AND TENNSSEE VALLEY. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION. THE POPULATION OF WASHINGTON COUNTY IS 55,190 AND ACCORDING TO THE U.S. CENSUS BUREAU, THE CITY OF ABINGDON HAS A POPULATION OF 8,183. 20.5% OF ABINGDON'S POPULATION IS AGE 65 AND OVER. ABINGDON HAS A MEDIAN HOUSEHOLD INCOME OF $39,393, WHICH IS SIGNIFICANTLY BELOW VIRGINIA'S MEDIAN HOUSEHOLD INCOME. IT IS ESTIMATED THAT 19.3% OF WASHINGTON COUNTY'S RESIDENTS LIVE IN POVERTY COMPARED TO 10.7% STATEWIDE. PART VI, LINE 5: THE MAJORITY OF JMH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY JMH.JMH IS DEDICATED TO OPERATING ITS FACILITIES EFFICIENTLY SO THAT WASTE IS MINIMIZED AND SURPLUSES MAY BE APPLIED TO MAINTAINING ADEQUATE FACILITIES AND EQUIPMENT FOR THE CARE OF OUR PATIENTS. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. PART VI, LINE 6: JMH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE. MSHA IS INTEGRATED BOTH VERTICALLY AND HORIZONTALLY AND IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. JMH SERVES AS THE COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM JMH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. REPORTS FILED WITH STATES PART VI, LINE 7 VA 1 ABINGDON AMBULANCE SERVICE 611 CAMPUS DRIVE SUITE 600 ABINGDON VA 24210 541061835 501(C)(3) 6929 FMV MEDICAL SUPPLIES TO RESTOCK EMS VEHICLES AMERICAN CANCER SOCIETY PO BOX 246 ABINGDON VT 24212 237040934 501(C)(3) 5000 GENERAL DONATION EMORY AND HENRY COLLEGE PO BOX 947 EMORY VA 24327 540505892 501(C)(3) 10500 GENERAL SUPPORT AND SCHOLARSHIPS DISPENSARY OF HOPE 401A ELM STREET JOHNSON CITY TN 37601 620476282 501(C)(3) 10999 MEDICAL SUPPLIES DONATION OF MEDICAL SUPPLIES FOR THE INDIGENT 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X 1 1 X X X 0 1 0 0 0 0 0 0 0 DENNIS VONDERFECHT 0 764230 0 252675 0 82683 0 144600 0 22685 0 1266873 0 0 PAUL ARMSTRONG MD 0 317538 0 7920 626 0 0 12564 0 14033 626 352055 0 0 ANN FLEMING 0 345309 0 116778 0 39233 0 47553 0 19175 0 568048 0 0 SEAN MCMURRAY 0 249976 0 71152 0 16360 0 27987 0 18981 0 384456 0 0 JOHN JETER 0 128011 0 7225 0 6041 0 3955 0 17017 0 162249 0 0 STEPHEN GIVENS 0 176859 0 5240 0 10941 0 11026 0 18078 0 222144 0 0 DAMIAN SOOKLAL MD 0 236665 0 81429 0 23005 0 11358 0 12720 0 365177 0 0 STEVEN SIKORA MD 0 284157 0 49193 0 1146 0 9418 0 17733 0 361647 0 0 STEVEN BLANKENSHIP MD 0 247685 0 56086 0 10758 0 11868 0 17793 0 344190 0 0 DOUGLAS LAWLER MD 0 318251 0 0 0 815 0 20174 0 10965 0 350205 0 0 JACQUELYN EARLY MD 0 247229 0 57350 0 10150 0 3763 0 14099 0 332591 0 0 PART I, LINE 1A JMH PAYS TRAVEL EXPENSES FOR COMPANIONS OF BOARD MEMBERS AND EXECUTIVE STAFF DURING THE ANNUAL BOARD RETREAT. AN ITEMIZED LIST OF EXPENDITURES IS PROVIDED BY THE HOSTING RESORT TO JMH FOR APPROVAL AND SUBSEQUENT PAYMENT. EXPENSES NOT INCURRED FOR BONA FIDE BUSINESS PURPOSES ARE ANALYZED AND REPORTED AS PRESCRIBED BY APPLICABLE TAX LAWS. FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES ON COMMERCIAL FLIGHTS. PART I, LINE 4B PART I, LINE 4B: SEVERANCE NON-QUALIFIED EQUITY-BASED ANN FLEMING 0 35,303 0 ANN FLEMING PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE 457(F) PLAN IN A NON-QUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISIFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SESRVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE INTHE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON" OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24 MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURES. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3 JMH'S CEO SALARY AND BENEFITS ARE SUBJECT TO THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) COMPENSATION COMMITTEE PROCESS, WHEREBY THE MSHA CEO RECOMMENDS THE SALARY AND IT IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE, BASED UPON MARKET DATA MADE AVAILABLE BY THIRD PARTY CONSULTANTS. THE COMPENSATION COMMITTEE HAS FINAL APPROVAL OF MSHA'S CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR THE JMH CEO AND ALL OTHER EXECUTIVES WITHIN MSHA. FORM 990, PART VI, SECTION A, LINE 3 THE CORPORATION CONTRACTED WITH MOUNTAIN STATES HEALTH ALLIANCE (MSHA), A 50.1% MEMBER, TO PERFORM MANAGEMENT DUTIES. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION IS ORGANIZED AS A VIRGINIA NON-STOCK, NONPROFIT ORGANIZATION WITH TWO MEMBERS: MOUNTAIN STATES HEALTH ALLIANCE WHICH MAINTAINS A 50.1% MEMBERSHIP AND JOHNSTON MEMORIAL HEALTHCARE FOUNDATION WHICH MAINTAINS A 49.9% INTEREST. FORM 990, PART VI, SECTION A, LINE 7A THE MSHA CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE JOHNSTON MEMORIAL HOSPITAL CLASS IS ELECTED BY THE JOHNSTON MEMORIAL HEALTHCARE FOUNDATION'S BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD OF TRUSTEES ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY, DAY TO DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990, WHICH WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, WAS REVIEWED BY FINANCIAL MANAGEMENT PRIOR TO FILING. COPIES OF THE RETURN WERE MADE AVAILABLE TO THE BOARD TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT PROVIDES THE POLICY AND CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OR ATTESTING THEY HAVE "NONE", AND RETURN THE FORMS TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND THEY ENGAGE IN A CONFLICTED TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL THE CEO COMPENSATION IS SUBJECT TO THE MSHA COMPENSATION COMMITTEE PROCESS, WHEREBY THE MSHA CEO RECOMMENDS THE SALARY AND IT IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE, BASED UPON MARKET DATA MADE AVAILABLE BY THIRD PARTY CONSULTANTS, JUST LIKE ANY OTHER MSHA EXECUTIVE BELOW THE MSHA CEO AND CFO LEVEL. LINE 15B - COMPENSATION PROCESS FOR OFFICERS THE BOARD ALSO APPROVES PAY AND BENEFITS FOR THE CFO. THE COMPENSATION COMMITTEE REVIEWS AND HAS FINAL APPROVAL OF CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR ALL OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. TRUSTEE COMPENSATION: FORM 990, PART VII, SECTION A, HOSPITAL BOARD OF TRUSTEES MEMBERS PAUL ARMSTRONG, M.D., ANN FLEMING, LARAMIE TRIPLETT, MICHAEL SPIEGLER, AND DENNIS VONDERFECHT HAVE FORM 990 REPORTABLE RELATED COMPENSATION DERIVED FROM SERVICES THEY PROVIDED TO RELATED ORGANIZATIONS. THEY DO NOT RECEIVE COMPENSATION FOR SERVICES AS HOSPITAL BOARD TRUSTEES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: INTERCOMPANY DEBT FORGIVENESS ADJUSTMENT -27,911,988. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -14,543. OTHER CHANGES -6. BOOK/TAX DIFFERENCE FROM INVESTMENT PARTNERSHIP 20,570. NET UNREALIZED GAINS ON INVESTEMENTS 1,483,513. TOTAL TO FORM 990, PART XI, LINE 5: -26,422,454. ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 205485346 MEDICAL SERVICES VA 501(C)(3) LINE 11A, I JOHNSTON MEMORIAL HOSPITAL INC 0 MOUNTAIN STATES HEALTH ALLIANCE 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 620476282 HOSPITAL TN 501(C)(3) LINE 3 N/A 0 DICKENSON COMMUNITY HOSPITAL ONE HOSPITAL DRIVE CLINTWOOD VA 24228 770599553 HOSPITAL VA 501(C)(3) LINE 3 NORTON COMMUNITY HOSPITAL INC 0 SMYTH COUNTY COMMUNITY HOSPITAL 565 RADIO HILL ROAD MARION VA 24354 540794913 HOSPITAL VA 501(C)(3) LINE 3 MOUNTAIN STATES HEALTH ALLIANCE 0 NORTON COMMUNITY HOSPITAL INC 100 15TH STREET NW NORTON VA 24273 540566029 HOSPITAL VA 501(C)(3) LINE 3 MOUNTAIN STATES HEALTH ALLIANCE 0 JOHNSTON MEMORIAL HEALTHCARE FOUNDATION INC 16000 JOHNSTON MEMORIAL DRIVE ABINGDON VA 24211 262870970 SUPPORTING ORGANIZATION TO JMH VA 501(C)(3) LINE 11B, II N/A 0 MOUNTIAN STATES FOUNDATION 2335 KNOB CREEK ROAD STE 101 JOHNSON CITY TN 37604 581418862 FUNDRAISING FOR MSHA HOSPITALS TN 501(C)(3) LINE 11A, I MOUNTAIN STATES HEALTH ALLIANCE 0 MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 581418345 SUPPORTING ORGANIZATION TO MSHA HOSPITALS TN 501(C)(3) LINE 11A, I N/A 0 COMMUNITY HEALTHCARE FOUNDATION 100 15TH STREET NW NORTON VA 24273 542002314 SUPPORTING ORGANIZATION TO NCH VA 501(C)(3) LINE 11A, I N/A 0 INTEGRATED SOLUTIONS HEALTH 400 N STATE OF FRANKLIN ROAD JOHNSON CITY TN 37604 621711997 INVESTMENT COMPANY TN N/A EMMAUS COMMUNITY HEALTHCARE PLLC 6070 HWY 11E PINEY FLATS TN 37686 200577483 MEDICAL SERVICES TN N/A MEDICAL SPECIALISTS OF JOHNSON CITY LLC 2528 WESLEY ST STE 2 JOHNSON CITY TN 37604 272199037 MEDICAL SERVICES TN N/A COMMUNITY HOME CARE INC 1640 PARK AVENUE NORTON VA 24273 541453810 MEDICAL PRODUCTS VA N/A C COMMUNITY PHYSICIAN SERVICES CORP 100 15TH STREET NW NORTON VA 24273 541641446 PHYSICIAN SERVICES VA N/A C SOUTHWEST COMMUNITY HEALTH SERVICES PO BOX 880 MARION VA 24354 541460695 HEALTH SERVICES VA N/A C BLUE RIDGE MEDICAL MANAGEMENT CORPORATION 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621490616 PHYSICIAN OFFICES TN N/A C MEDISERVE MEDICAL EQUIP OF KINGSPORT 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37064 621212286 DURABLE MEDICAL EQUIPMENT TN N/A C MOUNTAIN STATES PROPERTIES 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621845895 PROPERTY MANAGEMENT TN N/A C MOUNTAIN STATES PHYSICIANS GROUP INC 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY TN 37604 621700412 HEALTHCARE SERVICES TN N/A C WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY TN 37602 620329587 PHARMACY TN N/A C CRESTPOINT HEALTH INSURANCE CO INC 208 SUNSET DRIVE SUITE 101 JOHNSON CITY TN 37604 620381170 INSURANCE TN N/A C 0 1 1 0 0 0 0 0 1 0 1 1 0 1 1 1 0 1 ABINGDON PHYSICIAN PARTNERS B 7975295 COST